"I'm Coming Home, Tell the World I'm Coming Home". The Long Homecoming and Mental Health Treatment of Iraq and Afghanistan War Veterans

"What gets people in the door": An integrative model of student veteran mental health service use and opportunities for communication

Objective: To explore barriers and facilitators to mental health care among the student service member and veteran (SSM/V) population, develop an integrative model of mental health service use, and identify health communication opportunities. Participants: Participants were 21 current and former SSM/Vs recruited online and via snowball sampling. Methods: We conducted an emergent thematic analysis of in-depth interviews that took place in February 2021. Results: We identified eight major themes. Two were contextual (military culture, SSM/V identities), three were navigational (career repercussions, recognizing need, service availability/quality), and three were paths forward (high-quality accessible services, veteran peers/spaces, relevant outreach). Conclusions: We recommend higher education institutions promote SSM/V spaces, position mental health care as utilitarian, improve everyday mental health literacy, highlight service accessibility and quality, and deliver communications that reflect the diversity of SSM/V identities beyond the "warrior" archetype.

Exploring the Role of Social Connection in Interventions With Military Veterans Diagnosed With Post-traumatic Stress Disorder: Systematic Narrative Review

Background

It has been identified that military veterans have distinct experiences of loneliness and social isolation and, when comparing this community to other client groups with a PTSD diagnosis, veterans respond less favorably to treatment. However, the link between PTSD and loneliness for veterans remains insufficiently researched and it is unclear if there are effective interventions tackling this distinct experience of loneliness.

Aims

This systematic narrative review aimed to synthesize existing evidence incorporating elements of social connection, social isolation, and loneliness within interventions for military veterans with a diagnosis of PTSD, consequently aiming to examine the impact of such interventions upon this community.

Methods

Six databases were searched, utilizing relevant search criteria, with no date restrictions. Articles were included if they involved intervention or treatment for military veterans with PTSD and considered elements of social connection, social isolation, and/or loneliness. The initial search returned 202 papers. After exclusions, removal of duplications, and a reference/citation search, 28 papers remained and were included in this review.

Results

From the 28 studies, 11 directly addressed social isolation and two studies directly addressed loneliness. Six themes were generated: (i) rethinking the diagnosis of PTSD, (ii) holistic interventions, (iii) peer support, (iv) social reintegration, (v) empowerment through purpose and community, and (vi) building trust.

Conclusions

A direct focus upon social reintegration and engagement, psychosocial functioning, building trust, peer support, group cohesiveness and empowerment through a sense of purpose and learning new skills may mitigate experiential loneliness and social isolation for veterans with PTSD. Future research and practice should further explore the needs of the PTSD-diagnosed veteran community, seek to explore and identify potential common routes toward the development of PTSD within this community and consider bespoke interventions for tackling loneliness.

Thank You for Hearing My Voice - Listening to Women Combat Veterans in the United States and Israeli Militaries

The military service of combat soldiers may pose many threats to their well being and often take a toll on body and mind, influencing the physical and emotional make-up of combatants and veterans. The current study aims to enhance our knowledge about the combat experiences and the challenges that female soldiers face both during and after their service. The study is based on qualitative methods and narrative analysis of in-depth semi-structured personal interviews with twenty military veterans. It aims to analyze the narratives of American and Israeli female combat soldiers regarding their military service, with emphasis on the soldiers' descriptions, in their own words, about their difficulties, challenges, coping and successes during their service and transition to civilian life. A recurring theme in the interviews with the veterans of both militaries was the need to be heard and the fact that societies, therapists, and military institutions do not always truly listen to female veterans' experiences and are not really interested in what actually ails them. Our research suggests that conventional methods used in research relating to veterans might at times be inadequate, because the inherent categorization might abstract, pathologize, and fragment a wide array of soldiers' modes of post-combat being. Moreover, female veterans' voices will not be fully heard unless we allow them to be active participants in generating knowledge about themselves.

In Their Own Words: Veteran Experiences with Evidence-Based Treatments for PTSD in the Veterans Health Administration

The aim of the present study was to increase the understanding of veteran experiences with receiving an evidence-based psychotherapy (EBPs) for PTSD (Cognitive Processing Therapy and Prolonged Exposure therapy) in the Veterans Affairs Healthcare System (VA). Eighteen veterans who participated in the study were being seen in the outpatient PTSD clinic at a New England VA and had elected to participate in an EBP. The study assessed veteran experiences with, and outcomes from, treatment through the use of both quantitative and qualitative assessment tools. A rigorous data analytic approach, Consensual Qualitative Research, was applied to narrative data. Results fell into seven domains: Previous EBP & Outcome, Barriers to Treatment, Treatment Process, Treatment Outcome, Treatment Drop Out, and Feelings about Treatment. Overall, veterans reported diverse reactions to the EBPs for PTSD and identified both positive and negative aspects of the treatments. They identified multiple barriers to treatment completion and provided insight into their thoughts and feelings during the treatment protocol. Veterans who chose to drop out of treatment prematurely identified the factors that contributed to this decision. In this way, the study offers an initial but important look at veteran perceptions of and experiences with EBPs for PTSD.

Themes in experiences of PTSD symptoms and relationships among male veterans with risky sexual behavior

OBJECTIVE

United States veterans with posttraumatic stress disorder (PTSD) symptoms are at elevated risk for high-risk sexual behavior (HRSB). Although quantitative research has examined relationships between PTSD symptoms and HRSB, qualitative research to understand the lived experiences of veterans with PTSD symptoms and HRSB has not been conducted.

METHOD

Qualitative interviews were conducted with N = 29 male veterans of Operation Enduring Freedom or Operation Iraqi Freedom who had PTSD symptoms and reported recent HRSB. The interviews were analyzed using a phenomenological framework.

RESULTS

Six themes emerged: (a) avoiding social contact due to feeling different since return from service; (b) effortful self-management; (c) supportive relationships; (d) sex as a means to an end; (e) sex, risk, and intimacy; and (f) responsibility and growth.

CONCLUSION

Male veterans with PTSD symptoms and HRSB reported engagement in significant self-management to reengage in life, and still reported high levels of difficulty in relationships. They described both wanting to avoid perceived risk associated with intimate relationships and wanting to take risks that caused them to feel alive. Implications for treatment include increased efforts to facilitate coping, to recognize and moderate risk-taking urges, and to build intimacy and trust. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

In Their Own Words: Clinician Experiences and Challenges in Administering Evidence-Based Treatments for PTSD in the Veterans Health Administration

The aim of the present study was to increase the understanding of clinician experiences with administering two evidence-based psychotherapies (EBPs) for PTSD (Cognitive Processing Therapy and Prolonged Exposure therapy) in the Veterans Affairs Healthcare System (VA). The study assessed clinician perceptions through the use of two, one-hour focus groups and employed a rigorous data analysis approach, Consensual Qualitative Research. Clinicians who work in an outpatient PTSD clinic at a New England VA, and who routinely administer EPBs for PTSD, participated in the study. Results were categorized into seven domains by the coding team, including 1) EBP Strengths, 2) EBP Weaknesses, 3) Challenges Specific to the Veteran Population, 4) Perceived EBP Effectiveness, 5) Active Ingredients for Treating PTSD, 6) Treatment Structure and Process, and 7) Suggested Changes/Improvements to EBPs. These domains are discussed in detail, with several core ideas falling under each domain. Operational definitions and representative quotes are provided. Overall, clinicians provided a balanced perspective and identified both strengths and weaknesses of the EBPs for PTSD. They identified several challenges in applying these treatments to veteran populations, and shared their beliefs about treatment effectiveness, how they use these treatments in their clinical practice, and how they would change the treatments if given an opportunity to do so. In this way, the study offers a small but important step in attempting to address the science-practice gap related to EBP for PTSD implementation efforts in the VA.

Why People Who Inject Drugs Voluntarily Transition Off Methadone in Ukraine

Methadone maintenance therapy (MMT) treats opioid use disorder among people who inject drugs (PWID). To understand why PWID may voluntarily discontinue MMT, we analyzed data from 25 focus groups conducted in five Ukrainian cities from February to April 2013 with 199 participants who were currently, previously, or never on MMT. Using constant comparison method, we uncovered three themes explaining why PWID transition off MMT: (a) purposeful resistance to rigid social control associated with how MMT is delivered and to power asymmetries in provider-patient relationships, (b) self-management of a PWID's "wounded identity" that is common in socially stigmatized and physically sick persons-MMT serves as a reminder of their illness, and (c) the quest for a "normal life" uninterrupted by daily MMT site visits, harassment, and time inefficiencies, resources, and social capital. Focusing on holistic principles of recovery would improve addiction treatment and HIV prevention in Ukraine and globally.